tetanus is a communicable disease caused by Clostridium tetani.

1. TETANUS
BY
SUDHA SANJIBANEE
ROLL NO.:17
2ND YEAR
BSC.NURSING
GOPABANDHU INSTITUTE OF MEDICAL
SCIENCE AND RESEARCH SCHOOL AND
COLLEGE OF NURSING, MADHAPUR,
ATHAGARH, CUTTACK

2. INTRODUCTION
Arises from Greek word ‘Tetanos’ meaning strech
Tetanus is an infection caused by bacteria called
Clostridium tetani. When the bacteria invade the body,
they produce a poison (toxin) that causes painful muscle
contractions. Another name for tetanus is “lockjaw”. It
often causes a person’s neck and jaw muscles to lock,
making it hard to open the mouth or swallow.The
bacteria are usually found in soil, dust, and manure and
enter the body through breaks in the skin — usually cuts
or puncture wounds caused by contaminated objects.

3. DEFINITION
Tetanus is an acute bacterial disease caused
by the neurotoxin tetanospasmin elaborated
by Clostridium tetani and characterized by a
prolonged contraction of skeletal muscle
fibers(also called lockjaw).

4. EPIDEMIOLOGICAL FACTORS
 AGENT-CLOSTRIDIUM TETANI,A motile, GRAM-
POSITIVE, spore forming bacterium which
produces neurotoxin called tetanospasm
Found in two forms:
1. Dormant form (spores)
2. Active form (vegetative).
 RESERVOIR:Humans, domestic & wild animals
 INCUBATION PERIOD:Usually incubation period
ranges from 3-21 days but can range from the
day of injury to several months.

5.  Temporal pattern: Peak in winter and summer season
 IMMUNITY:tetanus do not have natural immunity
 MODE OF TRANSMISSION:Tetanus bacteria are found
in soil, dust, and manure. It gets into the body
through breaks in the skin, including:
 Contaminated wounds
 The injury Surgery, Burns, Deep Puncture Wounds,
Crush Wounds, otisis Media, Dental Infection,
Animal bites, Abortion, and pregnancy.
 Communicability: Not directly transmitted from
person to person i.e. ‘infectious but not contagious’

6.  Age: It is the disease of active age (5-40 year),
New born baby, female during delivery or abortion
 Sex: males> females
 Occupation: Agricultural workers are at higher
risk
 Rural > Urban areas
 Environmental and social factors: Unhygienic
custom habits, Unhygienic delivery practices
 Distribution: Tetanus occurs worldwide and is
endemic in many developing countries.Incidence
in developed countries is low due to effective
vaccination programs.

7. PATHOPHYSIOLOGY
Clostridium Tetani enters damaged tissue
Tetanus toxin is produced
Tetanospasmin is carried to the spinal cord and brain
stem and binds to receptors
Blocks neurotransmission

8. Damaged upper motor neurons lose the ability to
inhibit lower motor neurons
Uncontrolled reflex responses to afferent sensory
stimuli
Spasm and rigidity at the site of injury
Onset of sign and Symptoms

9. CLINICAL MANIFESTATIONS
The most common initial sign is spasms of the muscles of the jaw,
or “lockjaw”.
Tetanus symptoms include:
 Jaw cramping
 Sudden, involuntary muscle tightening (muscle spasms) – often
in the stomach
 Painful muscle stiffness all over the body
 Trouble swallowing
 Jerking or staring (seizures)
 Headache
 Fever and sweating
 Changes in blood pressure and fast heart rate

10. INVESTIGATION
Diagnosis is made on the basis of clinical findings and history.
 History collection:history of injury and possible
contamination.
 Physical examination
However certain indirect lab.investigations are done rarely.
 Wound cultures: In suspected cases, C. tetani can be
isolated from wounds of patients without tetanus &
frequently can not be isolated from wounds of those with
tetanus.
 Electromyograms: Continuous discharge of motor units,
shortening/ absence of sent interval seen after AP
 Muscle enzymes: Rased

11. COMPLICATIONS
Serious health problems that can happen because of tetanus include:
 Uncontrolled/involuntary tightening of the vocal cords
(laryngospasm)
 Broken bones (fractures)
 Infections gotten by a patient during a hospital visit (hospital-
acquired infections)
 Blockage of the main artery of the lung or one of its branches by a
blood clot that has travelled from elsewhere in the body through the
bloodstream (pulmonary embolism)
 Pneumonia, a lung infection, that develops by breathing in foreign
materials (aspiration pneumonia)
 Breathing difficulty, possibly leading to death (1 to 2 in 10 cases are
fatal)

12. PREVENTION
 DTaP vaccine — protects against diphtheria, tetanus, and
whooping cough (for infants and children)DTaP immunizations
are given as a series of 5 injections at ages:
 2 months
 4 months
 6 months
 15–18 months
 4–6 years
 Tdap vaccine — protects against diphtheria, tetanus, and
whooping cough (for preteens, teens, and adults)
 Td vaccine – protects against diphtheria and tetanus (for
adults)

13. TREATMENT
Tetanus is a medical emergency requiring care in the
hospital.It involves 4steps as follows:
1. Wound care
2. Medications
3. Supportive care
4. Vaccination:People who recover from tetanus do not
have natural immunity and can be infected again,
and therefore need to be immunized.
Wound care:Clean wound thoroughly by mild soap &
water to remove dirt, foreign bodies and dead tissue
from wound to prevent growth of tetanus spores.

14. Medications:
 Control of spasm:Injection diazepam 0.1-0.2mg/kg.
 Antibiotics:Broad spectrum antibiotics to treat or
prevent infection.
 Sedatives. Sedatives to control muscle spasms.
 Benzodiazepines,Lorazepam,Phenobarbital+Benzodiazepi
nes(for longer effect)
 Other drugs. Like magnesium sulfate, beta blockers &
morphine to regulate involuntary muscle activity,
regularize heartbeat and breathing
 IV fluids
Supportive therapies: Long period of treatment in an intensive
care settings. E.g. ventilator

15. ROLE OF NURSE
 Assess predisposing factors to pain
 Monitor vital signs
 Conduct diversion activities
 Offer other comfort measures (i.e., back rub)
 Provide a peaceful and calm environment
 Administer analgesics and pain medications as
ordered

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